Although use of patient-controlled analgesia (PCA) has many benefits, The Joint Commission Sentinel Event Alert on safe use of opioids in hospitals cautions:

“While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation.”



According to Dr. Robert Stoelting (President, Anesthesia Patient Safety Foundation), more than 13 million patients each year receive PCA in the US. An estimated 0.16 to 5.2% of these patients will suffer respiratory depression. This means that between 20,800 to 676,000 PCA patients will experience opioid-induced respiratory depression.

To improve opioid safety and patient outcomes, the Anesthesia Patient Safety Foundation recently released recommendations calling for continuous electronic monitoring of oxygenation and ventilation. As Dr. Robert Stoelting (President, Anesthesia Patient Safety Foundation) explains:

“Clinically significant drug-induced respiratory depression (oxygenation and/or ventilation) in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality.”

To address this issue of opioid-induced respiratory depression and the need for patient monitoring, PPAHS has engaged in numerous initiatives and activities, including:

  • Patient Safety Checklist: Development of a safety checklist regarding use of patient-controlled analgesia.
  • Media Resource:PPAHS has received frequent media requests to comment, answer questions and or to submit articles by the many media outlets including:
    • ABC News
    • Becker’s Hospital Review
    • CBS News
    • Hospitalist News
    • Internal Medicine News
    • Los Angeles Times
    • Outpatient Surgery
    • Patient Safety & Quality Healthcare
    • Project Health Radio
    • SurgiStrategies
    • UK Daily Mail
    • USA Today
  • Best Practices: Promoted best practices illustrated by health care expert studies and examples, such as how:
    • U.S. Department of Veterans Affairs believes it can prevent more than 60 percent of adverse events related to patient-controlled analgesia pumps.
    • St. Joseph’s/Candler Hospitals in Savannah, Georgia, has not only had eight years of event-free use of PCA using “smart” PCA pumps with integrated capnography monitoring, but calculated that their decision made great financial sense: (a) $4 million — estimated potential expenses averted (not including potential litigation costs); and (b) $2.5 million — 5-year return on investment.
    • Wesley Medical Center in Wichita, Kansas, for RT Magazine’s “Best of 2013 Respiratory Care Award” for bringing the percentage of moderate and severe patient-controlled analgesia adverse events progressing to code blue 13 percent to zero percent.

2 thoughts on “Opioids Safety No patient shall be harmed by opioids in-hospital

    • Michael Wong

      Thank you, Shree for sharing this article, which points out that “Within hospitals it’s routinely referred to as “Dead in Bed” — a tragic but preventable consequence of the impact of opioids widely used to relieve patient pain following surgery where patients’ breathing slows to critical levels.”

      Media and national attention to end the opioid epidemic is centered on the improper use of opioids in the community (addiction, misuse, diversion, etc). However, the truth is that opioid harm exists across a continuum of care – and, for many Americans, it starts in the hospital, not on the street.

      Stopping the opioid epidemic and preventing new addicts and abusers begins in the hospital and doctor’s office.

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